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Alcohol Intoxication and Glasgow Coma Scale Scores in Patients with Head Trauma

  • Park, Jisoo (Department of Emergency Medicine, National Medical Center) ;
  • Park, Taejin (Department of Emergency Medicine, National Medical Center) ;
  • Ko, Jung-In (Department of Emergency Medicine, National Medical Center) ;
  • Yeo, Woonhyung (Department of Emergency Medicine, Seongnam Citizens Medical Center)
  • Received : 2020.08.14
  • Accepted : 2020.10.12
  • Published : 2020.12.30

Abstract

Purpose: Alcohol intoxication is commonly associated with traumatic brain injury (TBI), but the influence of alcohol on the Glasgow Coma Scale (GCS) score remains unclear. This study investigates the effects of blood alcohol concentration (BAC) on the GCS score in head trauma patients with alcohol intoxication. Methods: In total, 369 head trauma patients with alcohol intoxication in a 1-year period were retrospectively analyzed. The patients underwent head computed tomography and had a BAC ≥80 mg/dL. Patients were divided into TBI and non-TBI groups. Brain injury severity was further classified using the head Abbreviated Injury Score (AIS). The effects according to 5 BAC groups were examined. Results: The TBI group consisted of 64 patients (16.2%). The mean BAC was significantly higher in the non-TBI group (293.4±87.3 mg/dL) than in the TBI group (242.8±89.9 mg/dL). The mean GCS score was significantly lower in the TBI group (10.3±4.6) than in the non-TBI group (13.0±2.5). A higher BAC showed a significant association with a lower mean GCS score in the TBI group, but not in the non-TBI group. Above ≥150 mg/dL, higher BACs showed significant odds ratios for a lower GCS score. Conclusions: The influence of alcohol in patients with head trauma depended on the presence of a brain injury. An association between a higher BAC and a lower GCS score was only observed in patients with TBI. Therefore, if a severe brain injury is suspected based on a GCS evaluation in patients with alcohol intoxication, prompt diagnosis and intensive care should be performed without delay.

Keywords

References

  1. Ghajar J. Traumatic brain injury. Lancet 2000;356:923-9. https://doi.org/10.1016/S0140-6736(00)02689-1
  2. Tagliaferri F, Compagnone C, Korsic M, Servadei F, Kraus J. A systematic review of brain injury epidemiology in Europe. Acta Neurochir (Wien) 2006;148:255-68; discussion 268. https://doi.org/10.1007/s00701-005-0651-y
  3. Thurman DJ, Alverson C, Dunn KA, Guerrero J, Sniezek JE. Traumatic brain injury in the United States: a public health perspective. J Head Trauma Rehabil 1999;14:602-15. https://doi.org/10.1097/00001199-199912000-00009
  4. Grote S, Bocker W, Mutschler W, Bouillon B, Lefering R. Diagnostic value of the Glasgow Coma Scale for traumatic brain injury in 18,002 patients with severe multiple injuries. J Neurotrauma 2011;28:527-34. https://doi.org/10.1089/neu.2010.1433
  5. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974;2:81-4. https://doi.org/10.1016/S0140-6736(02)93219-8
  6. Sloan EP, Zalenski RJ, Smith RF, Sheaff CM, Chen EH, Keys NI, et al. Toxicology screening in urban trauma patients: drug prevalence and its relationship to trauma severity and management. J Trauma 1989;29:1647-53. https://doi.org/10.1097/00005373-198912000-00011
  7. Johnston JJ, McGovern SJ. Alcohol related falls: an interesting pattern of injuries. Emerg Med J 2004;21:185-8. https://doi.org/10.1136/emj.2003.006130
  8. Alexander S, Kerr ME, Yonas H, Marion DW. The effects of admission alcohol level on cerebral blood flow and outcomes after severe traumatic brain injury. J Neurotrauma 2004;21:575-83. https://doi.org/10.1089/089771504774129900
  9. Brickley MR, Shepherd JP. The relationship between alcohol intoxication, injury severity and Glasgow Coma Score in assault patients. Injury 1995;26:311-4. https://doi.org/10.1016/0020-1383(95)00034-7
  10. Rundhaug NP, Moen KG, Skandsen T, Schirmer-Mikalsen K, Lund SB, Hara S, et al. Moderate and severe traumatic brain injury: effect of blood alcohol concentration on Glasgow Coma Scale score and relation to computed tomography findings. J Neurosurg 2015;122:211-8. https://doi.org/10.3171/2014.9.JNS14322
  11. Shahin H, Gopinath SP, Robertson CS. Influence of alcohol on early Glasgow Coma Scale in head-injured patients. J Trauma 2010;69:1176-81; discussion 1181. https://doi.org/10.1097/TA.0b013e3181edbd47
  12. Stuke L, Diaz-Arrastia R, Gentilello LM, Shafi S. Effect of alcohol on Glasgow Coma Scale in head-injured patients. Ann Surg 2007;245:651-5. https://doi.org/10.1097/01.sla.0000250413.41265.d3
  13. Hall D, Riley J, Swann I. Can alcohol intoxication be excluded as the cause of confusion following head injury? Scott Med J 2005;50:24-6. https://doi.org/10.1177/003693300505000110
  14. Lange RT, Iverson GL, Brubacher JR, Franzen MD. Effect of blood alcohol level on Glasgow Coma Scale scores following traumatic brain injury. Brain Inj 2010;24:919-27. https://doi.org/10.3109/02699052.2010.489794
  15. Pories SE, Gamelli RL, Vacek P, Goodwin G, Shinozaki T, Harris F. Intoxication and injury. J Trauma 1992;32:60-4. https://doi.org/10.1097/00005373-199201000-00013
  16. Sperry JL, Gentilello LM, Minei JP, Diaz-Arrastia RR, Friese RS, Shafi S. Waiting for the patient to "sober up": effect of alcohol intoxication on Glasgow Coma Scale score of brain injured patients. J Trauma 2006;61:1305-11. https://doi.org/10.1097/01.ta.0000240113.13552.96
  17. Ronning P, Gunstad PO, Skaga NO, Langmoen IA, Stavem K, Helseth E. The impact of blood ethanol concentration on the classification of head injury severity in traumatic brain injury. Brain Inj 2015;29:1648-53. https://doi.org/10.3109/02699052.2015.1075154
  18. Roozenbeek B, Lingsma HF, Perel P, Edwards P, Roberts I, Murray GD, et al. The added value of ordinal analysis in clinical trials: an example in traumatic brain injury. Crit Care 2011;15:R127. https://doi.org/10.1186/cc10240
  19. Walls RM, Hockberger R, Gausche-Hill M. Rosen's emergency medicine: concepts and clinical practice 9th edition. Philadelphia:Elsevier;2018.
  20. Easter JS, Haukoos JS, Claud J, Wilbur L, Hagstrom MT, Cantrill S, et al. Traumatic intracranial injury in intoxicated patients with minor head trauma. Acad Emerg Med 2013;20:753-60. https://doi.org/10.1111/acem.12184
  21. Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med 2000;343:100-5. https://doi.org/10.1056/NEJM200007133430204
  22. Galbraith S, Murray WR, Patel AR, Knill-Jones R. The relationship between alcohol and head injury and its effect on the conscious level. Br J Surg 1976;63:128-30. https://doi.org/10.1002/bjs.1800630210
  23. Jagger J, Fife D, Vernberg K, Jane JA. Effect of alcohol intoxication on the diagnosis and apparent severity of brain injury. Neurosurgery 1984;15:303-6. https://doi.org/10.1227/00006123-198409000-00002
  24. Minion GE, Slovis CM, Boutiette L. Severe alcohol intoxication: a study of 204 consecutive patients. J Toxicol Clin Toxicol 1989;27:375-84. https://doi.org/10.3109/15563658909000358